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Zhang G, Chen W, Chen H, Lin J, Cen LP, Xie P, Zheng Y, Ng TK, Brelén ME, Zhang M, Pang CP. Risk factors for diabetic retinopathy, diabetic macular edema, and sight-threatening diabetic retinopathy. Asia Pac J Ophthalmol (Phila) 2024:100067. [PMID: 38750958 DOI: 10.1016/j.apjo.2024.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE To identify the risk factors for the development of diabetic retinopathy (DR), diabetic macular edema (DME), and sight-threatening DR (STDR) based on a city-wide diabetes screening program. RESEARCH DESIGN AND METHODS Diabetic patients were prospectively recruited between June 2016 and December 2022. All patients underwent dilated fundus photography centered on the disc and macula or macular spectral domain optical coherence tomography (SD-OCT) scan. Complete medical history was documented. Systematic examination, blood analysis, and urinalysis were performed. Multivariate logistic regression analysis adjusting for age and sex was conducted. RESULTS Out of 7274 diabetic patients, 6840 had gradable images, among which 3054 (42.0%) were graded as DR, 1153 (15.9%) as DME, and 1500 (20.6%) as STDR. The factors associated with DR, DME, and STDR included younger age (odds ratio [OR]: 0.96, 0.97, and 0.96 respectively), lower BMI (OR: 0.97, 0.95, and 0.95 respectively), longer duration of diabetes (OR: 1.07, 1.03, and 1.05 respectively) and positive of urinary albumin (OR: 2.22, 2.56, and 2.88 respectively). Other associated factors included elevated blood urea nitrogen (OR: 1.22, 1.28, and 1.27 respectively), higher LDL-cholesterol, lower blood hemoglobin (OR: 0.98, 0.98, and 0.98), insulin intake, presence of diabetic foot pathologies and diabetic peripheral neuropathy. We also identified novel risk factors, including high serum potassium (OR: 1.37, 1.46, and 1.55 respectively), high-serum sodium (OR: 1.02, 1.02, and 1.04 respectively). Better family income was a protective factor for DR, DME, and STDR. Alcohol consumption once a week was also identified as a protective factor for DR. CONCLUSIONS Similar risk factors for DR, DME, and STDR were found in this study. Our data also indicates high serum sodium, high serum potassium, low blood hemoglobin, and level of family income as novel associated factors for DR, DME, and STDR, which can help with DR monitoring and management.
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Affiliation(s)
- Guihua Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Weiqi Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Jianwei Lin
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Ling-Ping Cen
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Peiwen Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Yi Zheng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mårten Erik Brelén
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
| | - Chi Pui Pang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou, Guangdong, China; Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.
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Li J, Dong Z, Wang X, Wang X, Wang L, Pang S. Risk Factors for Diabetic Retinopathy in Chinese Patients with Different Diabetes Duration: Association of C-Peptide and BUN/Cr Ratio with Type 2 Diabetic Retinopathy. Int J Gen Med 2023; 16:4027-4037. [PMID: 37700740 PMCID: PMC10493150 DOI: 10.2147/ijgm.s420983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023] Open
Abstract
Background and Aim Controlling the risk factors was the most effective strategy to prevent diabetic retinopathy (DR). This study aimed to recognize the risk factors of DR, and explores whether the effect of those factors is modified by diabetes mellitus (DM) duration. Methods A total of 1058 DM patients with information about DR assessment were included. DR was measured by a complete ophthalmic examination and was classified as having one or more distinct microaneurysms in the eyes. Data from the lab and clinical factors were gathered. Multivariate logistic analysis was used to examine the risk factors, and the best-fitting model was selected by a backward stepwise based on A1C. Results In the current study, 274 (25.9%) patients developed DR. In the entire subjects, baseline age, the level of C-peptide, and urinary creatinine were all presented as protective effects of DR, whose odds ratios (ORs) and 95% confidence intervals (CIs) were 0.79 (0.62, 0.99), 0.75 (0.61, 0.91), and 0.70 (0.52, 0.93), respectively. Conversely, systolic pressure (SBP), urinary albumin, and BUN/Cr ratio were the important risk factors for DR with ORs (95% CIs) 1.21 (1.01, 1.46), 1.55 (1.30, 1.84), and 1.33 (1.11, 1.59), respectively. In stratification analysis, females with higher SBP would be more likely to develop DR in the short-duration group, while C-peptide and urinary creatinine showed protective effects in the long-duration group. BUN/Cr ratio all presented as a risk factor, with ORs 1.38 (p = 0.041) and 1.33 (p = 0.014) in short- and long-duration groups, respectively. Conclusion Although renal functions presented a significant association with DR in all DM patients, the risk factors of DR varied widely in different disease-duration subjects. Target strategies to prevent DR should be put forward individually, considering the patient's DM duration. Improving the BUN/Cr ratio may be beneficial to delaying DR.
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Affiliation(s)
- Jianting Li
- Department of Endocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250013, People’s Republic of China
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Zhenhua Dong
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Xiaoli Wang
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Xin Wang
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Lulu Wang
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
| | - Shuguang Pang
- Department of Endocrinology, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250013, People’s Republic of China
- Department of Endocrinology, Central Hospital Affiliated to Shandong First Medical University, Jinan, 250013, People’s Republic of China
- Department of Clinical Medicine, Weifang Medical College, Weifang Medical College, Weifang, People’s Republic of China
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Li H, Zhang L, Wang X, Wang W, Zhang J, Pan Q, Guo L. Direct medical cost and medications for patient of diabetes retinopathy in Beijing, China, 2016 to 2018. Diabetes Res Clin Pract 2023:110796. [PMID: 37355099 DOI: 10.1016/j.diabres.2023.110796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
AIMS Medications and costs of drug for diabetic retinopathy in outpatient in China have not been evaluated. The purpose of this study was to evaluate the hypoglycemic drugs and medical costs of diabetic retinopathy patients in the Beijing medical insurance system, analyze the characteristics of outpatient treatment, and investigate the changes in the quantity and cost of hypoglycemic drugs from 2016 to 2018 METHODS: This is a retrospective observational study, including diabetic patients with outpatient records in Beijing medical insurance from 2016 to 2018. Data on oral hypoglycemic drugs , insulin and non-hypoglycemic drugs, complications, treatment strategies, and annual medical costs were recorded Results: A total of 2,853,036 diabetic patients in Beijing medical insurance were enrolled in this study. 4.19%-4.67% of patients were diagnosed with retinopathy. Patients with retinopathy have more diabetic complications (1.65±0.71 vs 0.18±0.44. pp<.0001),and use more drugs (5.11±2.60 vs 3.85±2.34, pp <.0001), the annual total drug cost is also higher (¥ 13836±11244 vs ¥ 10030±9375, pp <.0001). The numbers of medication in retinopathy patients increased(5.11±2.60 vs 4.95±2.57, pp <.0001), and the annual total drug cost (¥13836±11244 vs ¥15642±13344, pp <.0001)decreased in 2018 compared with 2016. CONCLUSIONS Patients with retinopathy were associated with more complications. Compared with patients without retinopathy, the number of medications and total medical costs were significantly increased. From 2016 to 2018, there was an increase in the number of medication treatments for patients with retinopathy, but a decrease in cost.
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Affiliation(s)
- Hui Li
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Lina Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Xiaoxia Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Weihao Wang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Jie Zhang
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China
| | - Qi Pan
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
| | - Lixin Guo
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China.
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Li C, Zhu B, Zhang J, Guan P, Zhang G, Yu H, Yang X, Liu L. Epidemiology, health policy and public health implications of visual impairment and age-related eye diseases in mainland China. Front Public Health 2022; 10:966006. [PMID: 36438305 PMCID: PMC9682104 DOI: 10.3389/fpubh.2022.966006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022] Open
Abstract
The prevalence of visual impairment (VI) and age-related eye diseases has increased dramatically with the growing aging population in mainland China. However, there is limited comprehensive evidence on the progress of ophthalmic epidemiological research in mainland China to enhance our awareness of the prevention of eye diseases to inform public health policy. Here, we conducted a literature review of the population-based epidemiology of VI and age-related eye diseases in mainland China from the 1st of January 1946 to the 20th of October 2021. No language restrictions were applied. There was significant demographic and geographic variation in the epidemic of VI and age-related eye diseases. There are several factors known to be correlated to VI and age-related eye diseases, including age, gender, family history, lifestyle, biological factors, and environmental exposures; however, evidence relating to genetic predisposition remains unclear. In addition, posterior segment eye diseases, including age-related macular degeneration and diabetic retinopathy, are amongst the major causes of irreversible visual impairments in the senile Chinese population. There remains a significant prevention gap, with only a few individuals showing awareness and achieving optimal medical care with regards to age-related eye diseases. Multiple challenges and obstacles need to be overcome, including the accelerated aging of the Chinese population, the lack of structured care delivery in many underdeveloped regions, and unequal access to care. Despite the progress to date, there are few well-conducted multi-center population-based studies following a single protocol in mainland China, which findings can hopefully provide valuable cues for governmental decision-making and assist in addressing and halting the incidence of VI and age-related eye diseases in China.
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Affiliation(s)
- Cong Li
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,School of Medicine, South China University of Technology, Guangzhou, China
| | - Bo Zhu
- Cancer Hospital of China Medical University/Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Jie Zhang
- Department of Retina, Weifang Eye Hospital, Weifang, China
| | - Peng Guan
- Department of Epidemiology, School of Public Health, China Medical University, Shenyang, China
| | - Guisen Zhang
- Department of Retina, Inner Mongolia Chaoju Eye Hospital, Hohhot, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,*Correspondence: Honghua Yu
| | - Xiaohong Yang
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Xiaohong Yang
| | - Lei Liu
- Department of Ophthalmology, Guangdong Eye Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China,Lei Liu
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Tan H, Wang X, Ye K, Lin J, Song E, Gong L. Prevalence and risk factors of diabetic retinopathy among Chinese adults with type 2 diabetes in a suburb of Shanghai, China. PLoS One 2022; 17:e0275617. [PMID: 36194621 PMCID: PMC9531829 DOI: 10.1371/journal.pone.0275617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background To investigate the prevalence and risk factors of diabetic retinopathy (DR) in a Chinese population with type 2 diabetes mellitus (T2DM) in a suburb (Qingpu) of Shanghai, China. Methods A population-based cross-sectional study. A total of 7462 residents with T2DM in Qingpu were enrolled according to the resident health archives from January 2020 to December 2020. Blood and urine samples of the subjects were collected. Disc- and macula-centred retinal images were taken to assess DR. SPSS was used to analyse and investigate the prevalence and risk factors of DR. Results The fundus images of 6380 (85.5%) subjects were of sufficiently good quality for grading. The average (range) age of 6380 subjects was 63.46±7.77 (28–92) years. Six hundred forty-four subjects were diagnosed with DR. The prevalence of DR was 10.1% (95% CI 9.4%-10.8%), with mild, moderate, and severe non-proliferative retinopathy and proliferative retinopathy being 2.1%, 6.3%, 1.3% and 0.4%, respectively. The prevalence of bilateral DR was 6.5%. Higher T2DM duration (OR, 1.057), fasting plasma glucose (OR, 1.063), glycated hemoglobinA1c (OR, 1.269), urea nitrogen (OR, 1.059), and urinary albumin (OR, 1.001) were associated with the higher DR prevalence. Conclusion The prevalence of DR among Chinese adults with T2DM in Qingpu was 10.1%, in which non-proliferative DR was more common. Higher fasting plasma glucose and glycated hemoglobinA1c are well-known risk factors of DR, consistent with the findings in our study. Our study didn’t find the risk between lipid indicators and DR. However, several renal function indicators, like higher urea nitrogen and urinary albumin, were risk factors for DR in this study. Appropriate diagnosis and intervention should be taken in time to prevent and control DR development.
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Affiliation(s)
- Huiling Tan
- Department of Ophthalmology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Xin Wang
- Department of Ophthalmology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- Bengbu Medical College, Bengbu, Anhui, China
| | - Kaiyou Ye
- Qingpu Center for Disease Prevention and Control, Shanghai, China
| | - Jianmin Lin
- Clinical Laboratory, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - E. Song
- Department of Ophthalmology, Lixiang Eye Hospital of Soochow University, Suzhou, Jiangsu, China
- * E-mail: (ES); (LG)
| | - Lihua Gong
- Department of Ophthalmology, Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
- * E-mail: (ES); (LG)
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Yongpeng Z, Yaxing W, Jinqiong Z, Qian W, Yanni Y, Xuan Y, Jingyan Y, Wenjia Z, Ping W, Chang S, Ming Y, Yanan L, Jinyuan W, Shouling W, Shuohua C, Haiwei W, Lijian F, Qianqian W, Jingyuan Z, Zihan N, Yuning C, Ying X, Jonas JB, Wenbin W. The Association Between Diabetic Retinopathy and the Prevalence of Age-Related Macular Degeneration—The Kailuan Eye Study. Front Public Health 2022; 10:922289. [PMID: 35923972 PMCID: PMC9339787 DOI: 10.3389/fpubh.2022.922289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/10/2022] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate the prevalence of age-related macular degeneration (AMD) in patients with diabetes mellitus (DM) and diabetic retinopathy (DR) and analyze whether DR is a risk factor for AMD. This population-based epidemiological study included 14,440 people from the Kailuan Eye Study in 2016, of whom 1,618 were patients with type 2 DM aged over 50 years, and 409 had DM with DR. We analyzed whether there were differences in the prevalence of AMD between DM with DR and DM without DR, and conducted a hierarchical statistical analysis according to different stages of DR. Using variable regression analysis, we explored whether DR constituted a risk factor for AMD. In the DM population, the prevalence of wet AMD in patients with DM with and without DR was 0. 3 and 0.2%, respectively, with no significant difference (P = 0.607). Meanwhile, the prevalence of dry AMD in patients with DM with and without DR was 20.8 and 16.0%, respectively, with a significant difference. In the subgroup analysis of dry AMD, the prevalence of early, middle, and late dry AMD in DM with DR was 14.4, 5.9, and 0.5%, respectively. In DM without DR, the prevalence of early, middle, and late dry AMD was 10.5, 4.8, and 0.7%, respectively (P = 0.031). In the subgroup analysis of DR staging, statistical analysis could not be performed because of the limited number of patients with PDR. In the variable regression analysis of risk factors for dry AMD, after adjusting for age, sex, body mass index, hypertension, and dyslipidemia, DR constituted the risk factor for dry AMD. In conclusion, DM did not constitute a risk factor for AMD, and the prevalence of wet AMD and dry AMD in patients with DM and DR was higher than that in patients with DM without DR (among which dry AMD was statistically significant). Multivariate regression analysis confirmed that DR is an independent risk factor for dry AMD. Reasonable control of DM and slowing down the occurrence and development of DR may effectively reduce the prevalence of AMD in patients with DM.
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Affiliation(s)
- Zhang Yongpeng
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Yaxing
- Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing Tongren Eye Center, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhou Jinqiong
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Qian
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yan Yanni
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Xuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Jingyan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhou Wenjia
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Ping
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shen Chang
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Ming
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Luan Yanan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wang Jinyuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wu Shouling
- Cardiology Department, Kailuan General Hospital, Tangshan, China
| | - Chen Shuohua
- Health Care Center, Kailuan Group, Tangshan, China
| | - Wang Haiwei
- Department of Ophthalmology, Fuxing Hospital, Capital Medical University, Beijing, China
| | - Fang Lijian
- Department of Ophthalmology, Beijing Liangxiang Hospital, Capital Medical University, Beijing, China
| | - Wan Qianqian
- Department of Ophthalmology, The Second Hospital of Anhui Medical University, Hefei, China
| | - Zhu Jingyuan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nie Zihan
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chen Yuning
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xie Ying
- Department of Ophthalmology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Heidelberg, Germany
| | - Wei Wenbin
- Beijing Key Laboratory of Intraocular Tumor Diagnosis and Treatment, Beijing Ophthalmology and Visual Sciences Key Lab, Medical Artificial Intelligence Research and Verification Key Laboratory of the Ministry of Industry and Information Technology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- *Correspondence: Wei Wenbin
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Xiao Y, Liang Y, Lin Z, Kong H, Du Z, Hu Y, Ouyang S. Causes and Risk Factors of Repeated Hospitalization among Patients with Diabetic Retinopathy. J Diabetes Res 2022; 2022:4663221. [PMID: 35669395 PMCID: PMC9167072 DOI: 10.1155/2022/4663221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose To identify the causes and risk factors of repeated hospitalization among patients with diabetic retinopathy (DR). Methods Our study retrospectively examined the data of DR patients who were readmitted for treatments to the Department of Ophthalmology, Guangdong Provincial People's Hospital between January 2012 and July 2021. We first analyzed the main causes of repeated admissions and then divided the patients into three groups according to the times of readmissions. Ordinal logistic regression was performed to determine the impact of patients' demographic and clinical characteristics. Moreover, comparisons of the length of stay and the hospitalization cost of DR patients with repeated admission causes were conducted. Results Among 2592 hospital discharges of 827 patients who experienced at least two hospitalizations, the major causes of repeated hospitalization were macular edema (30.83%), vitreous hemorrhage (29.09%), cataract (22.76%), proliferative membrane formation (6.91%), silicone oil removal (4.71%), retinal detachment (4.44%), and glaucoma (4.17%). The results of ordinal logistic regression showed that younger patients with medical insurance and local residence have a higher risk of repeated hospitalization (p < 0.05). Furthermore, patients readmitted for vitreous hemorrhage, proliferative membrane formation, and retinal detachment experienced longer length of hospital stay and higher hospitalization cost (p < 0.001). Conclusions Multiple causes and risk factors contribute to repeated hospitalization, imposing a substantial physical and economic burden on DR patients. A better understanding of these causes and risk factors of readmission may lead to lowering such risks and alleviating patients' burden.
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Affiliation(s)
- Yu Xiao
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingying Liang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhanjie Lin
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Graduate School, Shantou University Medical College, Shantou, China
| | - Huiqian Kong
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yunyan Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shuyi Ouyang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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8
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Chung YC, Xu T, Tung TH, Chen M, Chen PE. Early Screening for Diabetic Retinopathy in Newly Diagnosed Type 2 Diabetes and Its Effectiveness in Terms of Morbidity and Clinical Treatment: A Nationwide Population-Based Cohort. Front Public Health 2022; 10:771862. [PMID: 35570930 PMCID: PMC9094682 DOI: 10.3389/fpubh.2022.771862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To characterize the association between the frequency of screening for diabetic retinopathy (DR) and the detection of DR in patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This nationwide population-based cohort study used data from the National Health Insurance Research Database to identify adult patients who were newly diagnosed with T2DM between 2000 and 2004. Data from their follow-up Diabetic retinopathy (DR) treatments over the next 10 years following diagnosis were also analyzed. Results The 41,522 subjects were respectively assigned to a periodic screening group (n = 3850) and nonperiodic screening group (n = 37,672). Significant differences were observed between the two groups in terms of age, Charlson Comorbidity Index (CCI), sex, DR treatment, and the prevalence of DR. The association between periodic screening and DR treatment, only the elderly, female, and patient with severe CCI status showed the significance in the further stratified analysis. Conclusion Periodic screening (annual or biannual screening in the first 5 years) was more effective than nonperiodic screening in detecting instances of DR in the middle-to-advanced aged group but not among younger patients. Screening pattern did not have a significant effect on the likelihood of DR-related treatment during the 5-year follow-up. It appears that a tight screening schedule for the first 5 years after diagnosis with diabetes is not necessary.
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Affiliation(s)
- Yu-Chien Chung
- Department of Ophthalmology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ting Xu
- Department Endocrinology and Metabolism, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Tao-Hsin Tung
- Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan.,Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pei-En Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.,Taiwan Association of Health Industry Management and Development, Taipei, Taiwan
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Liu J, Hu H, Qiu S, Wang D, Liu J, Du Z, Sun Z. The Prevalence and Risk Factors of Diabetic Retinopathy: Screening and Prophylaxis Project in 6 Provinces of China. Diabetes Metab Syndr Obes 2022; 15:2911-2925. [PMID: 36186939 PMCID: PMC9518998 DOI: 10.2147/dmso.s378500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To investigate the prevalence and associated factors of diabetic retinopathy (DR) and advanced DR in Chinese adults with diabetes mellitus (DM). PATIENTS AND METHODS A cross-sectional study was performed on 4831 diabetic patients from 24 hospitals from April 2018 to July 2020. Non-mydriatic fundus of patients were interpreted by an artificial intelligence (AI) system. Fundus photos that were unsuitable for AI interpretation were interpreted by two ophthalmologists trained by one expert ophthalmologist at Beijing Tongren Hospital. Medical history, height, weight, body mass index (BMI), glycosylated hemoglobin (HbA1c), blood pressure, and laboratory examinations were recorded. RESULTS A total of 4831 DM patients were included in this study. The prevalence of DR and advanced DR in the diabetic population was 31.8% and 6.6%, respectively. In multiple logistic regression analysis, male (odds ratio [OR], 1.39), duration of diabetes (OR, 1.05), HbA1c (OR, 1.11), farmer (OR, 1.39), insulin treatment (OR, 1.61), region (northern, OR, 1.78; rural, OR, 6.96), and presence of other diabetic complications (OR: 2.03) were associated with increased odds of DR. The factors associated with increased odds of advanced DR included poor glycemic control (HbA1c >7.0%) (OR, 2.58), insulin treatment (OR, 1.73), longer duration of diabetes (OR, 3.66), rural region (OR, 4.84), and presence of other diabetic complications (OR, 2.36), but overweight (BMI > 25 kg/m2) (OR, 0.61) was associated with reduced odds of advanced DR. CONCLUSION This study shows that the prevalence of DR is very high in Chinese adults with DM, highlighting the necessity of early diabetic retinal screening.
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Affiliation(s)
- Jiang Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
- Department of Endocrinology, The Third Hospital of Nanchang, Nanchang, Jiangxi, People’s Republic of China
| | - Hao Hu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
- Department of Endocrinology, The First People’s Hospital of Xuzhou, Xuzhou, Jiangsu, People’s Republic of China
| | - Shanhu Qiu
- Department of General Practice, Zhongda Hospital; Institute of Diabetes, School of Medicine, Southeast University, Nanjing, People’s Republic of China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jianing Liu
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Ziwei Du
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China
- Correspondence: Zilin Sun, Department of Endocrinology, Zhongda Hospital, Institute of Diabetes, School of Medicine, Southeast University, Nanjing, 210009, People’s Republic of China, Tel +8613951749490, Fax +862583262609, Email
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10
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Zhang Y, An X, Duan L, Jin D, Duan Y, Zhou R, Zhang Y, Kang X, Lian F. Effect of Chinese Patent Medicines on Ocular Fundus Signs and Vision in Calcium Dobesilate-Treated Persons With Non-Proliferative Diabetic Retinopathy: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2022; 13:799337. [PMID: 35370950 PMCID: PMC8967137 DOI: 10.3389/fendo.2022.799337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR), one of the commonest microvascular complications in diabetic patients, is featured by a series of fundus lesions. Conventional Western medicine therapies for DR are always with modest treatment outcome. This paper is to assess the ocular fundus signs, vision and safety of Chinese patent medicines (CPMs) as an add-on treatment for DR. METHOD 7 electronic databases were searched to determine eligible trials. Randomized controlled trials (RCTs) of non-proliferative diabetic retinopathy (NPDR) in which the intervention group received CPMs combined with calcium dobesilate (CD), and the control group received only CD were included for analysis. Two reviewers extracted the data independently. Results expressing as mean differences (MD) and relative risks (RR) were analyzed with a fixed-effects or random-effects models. RESULTS 19 RCTs involved 1568 participants with 1622 eyes met our inclusion criteria. The results suggested that compared with CD alone, CPMs plus CD for NPDR was superior at reducing the microaneurysm volume (MD -3.37; 95% confidence interval [CI], -3.59 to -3.14), microaneurysm counts (MD -2.29; 95%CI -2.97 to -1.61), hemorrhage area (MD -0.79; 95%CI -0.83 to -0.75), and macular thickness (MD -59.72; 95%CI -63.24 to -56.20). Participants in CPMs plus CD group also achieved a better vision. No obvious adverse events occurred. CONCLUSION CPMs as an add-on therapy for NPDR have additional benefits and be generally safe. This meta-analysis demonstrated that CPMs combined with CD could improve retinal microaneurysm, hemorrhage, macular thickness, visual acuity, fasting blood glucose (FBG), and glycosylated hemoglobin (HbAlc) compared with CD alone. Further studies are needed to provide more conclusive evidence. SYSTEMATIC REVIEW REGISTRATION PROSPERO https://www.crd.york.ac.uk/prospero/, identifier CRD42021257999.
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Affiliation(s)
- Yuehong Zhang
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuedong An
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liyun Duan
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - De Jin
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yingying Duan
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Rongrong Zhou
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuqing Zhang
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaomin Kang
- Clinical Department of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Fengmei Lian
- Department of Endocrinology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Fengmei Lian,
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Ding X, Rong S, Wang Y, Li D, Wen L, Zou B, Zang D, Feng K, Liang Y, Wang F, Zhai G. The Association of the Prevalence of Depression in Type 2 Diabetes Mellitus with Visual-Related Quality of Life and Social Support. Diabetes Metab Syndr Obes 2022; 15:535-544. [PMID: 35237054 PMCID: PMC8882658 DOI: 10.2147/dmso.s343926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022] Open
Abstract
AIM To report the prevalence of depression and its association with vision-related quality of life and social support in a type 2 diabetes mellitus (T2DM) population. METHODS Patients were recruited from a community-based study, Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), conducted between July 2012 and May 2013 in China. Depression was assessed using the Centre for Epidemiological Studies Depression Scale (CES-D). Vision-related quality of life was evaluated using the Visual Function Questionnaire-25 (VFQ-25). Social support was captured with the Social Support Rating Scale (SSRS). Generalized linear models were used to estimate the individual and joint association of VFQ-25 composite score (VFQCS) and SSRS score (SSRSS) with depression. RESULTS A total of 1618 subjects (60.9% female) aged 61.69 ± 8.72 years in an urban district of Jiangjun Street, Fushun City, Liaoning province, Northeast China from July 2012 to May 2013 were recruited, of which, 23.36% (95% CI: 21.30-25.42%) were identified with depression. Every 14.1 increase in VFQ-25 composite score decreased the risk of depression by half (OR = 0.5; 95% CI: 0.4-0.6); with the elevation of 10.0 SSRS score the risk of depression decreased by 40% (OR = 0.6; 95% CI: 0.5-0.7). Patients with the VFQCS less than 91.3 and SSRSS less than 38.0 had 5.9 times more risk of depression (OR = 5.9; 95% CI: 3.6-9.7). Age (over 60 years) (OR = 0.6; 95% CI: 0.4-0.9) and medical history of cardiovascular disease (OR = 1.7; 95% CI: 1.1-2.5) were independently correlated with depression symptom. CONCLUSION The prevalence of depression is high among patients with T2DM in urban district in northeast China. Vision-related quality of life and social support scores are significantly associated with depression. Measures should be taken to screen depressive symptoms in patients with type 2 diabetes patients. These patients need to be intervened with appropriate and effective treatment as early as possible. Meanwhile, behavioral health specialists should guide the patient to get and use social support sources effectively.
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Affiliation(s)
- Xiaoxia Ding
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Shisong Rong
- Department of Ophthalmology, Harvard Medical School, Massachusetts Eye and Ear, Boston, MA, USA
| | - Yu Wang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Dong Li
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Liang Wen
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Bo Zou
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Dongxiao Zang
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
| | - Kemi Feng
- Department of Ophthalmology, the Affiliated Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Yuanbo Liang
- Department of Ophthalmology, the Affiliated Eye Hospital, School of Optometry and Ophthalmology, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China
| | - Fenghua Wang
- Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, People’s Republic of China
| | - Gang Zhai
- Department of Ophthalmology, Fushun Eye Hospital, Fushun, Liaoning, People’s Republic of China
- Correspondence: Gang Zhai, Fushun Eye Hospital, No. 1 Hupo Street, Xinfu District, Fushun, Liaoning, 113008, People’s Republic of China, Email
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12
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Zhang P, Xue WW, Huang XB, Xu Y, Lu LN, Zheng KR, Zou HD. Prevalence and risk factors of diabetic retinopathy in patients with type 2 diabetes in Shanghai. Int J Ophthalmol 2021; 14:1066-1072. [PMID: 34282393 DOI: 10.18240/ijo.2021.07.16] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 01/02/2023] Open
Abstract
AIM To investigate the prevalence of diabetic retinopathy (DR) in residents of Shanghai and analyze the risk factors of DR. METHODS This study involved 7233 patients with diabetes in 2016. The demographic data of the participants were collected using a questionnaire survey. Physical examination, laboratory tests, and ophthalmological examinations were conducted. Two professional ophthalmologists diagnosed and graded DR by fundus examination and then combined the results with fundus images. The unconditional multivariate Logistic regression analysis was used to determine the risk factors. RESULTS In total, 6978 patients with type 2 diabetes in Shanghai with a mean age of 68.33±8.40y were recruited, including 2975 males (42.6%) and 4003 females (57.4%). Overall, 1184 patients were diagnosed with DR, with a prevalence rate of 16.97%. Regression analysis showed that duration of diabetes (OR 1.061, 95%CI 1.049-1.073), high systolic blood pressure (SBP; OR 1.071, 95%CI 1.037-1.106), increased glycosylated hemoglobin level (OR 1.234, 95%CI 1.162-1.311), high blood glucose level (OR 1.061, 95%CI 1.023-1.099), increased neutrophil-to-lymphocyte ratio (NLR; OR 1.132, 95%CI 1.053-1.217) and mean platelet volume (MPV; OR 1.077, 95%CI 1.016-1.142) were risk factors of DR. Conversely, hematocrit (HCT; OR 0.971, 95%CI 0.954-0.988) and mean corpuscular volume (MCV; OR 0.980, 95%CI 0.965-0.994) were protective factors. CONCLUSION The prevalence rate of DR in Shanghai is 16.97%. The duration of diabetes, high SBP, increased glycosylated hemoglobin, NLR, and MPV were determined as risk factors of DR.
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Affiliation(s)
- Pei Zhang
- Department of Ophthalmology, Shanghai Gonghui Hospital, Shanghai 200041, China
| | - Wen-Wen Xue
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Xiao-Bo Huang
- Department of Ophthalmology, the Second Affiliated Hospital of Nantong University, Nantong 226000, Jiangsu Province, China
| | - Yi Xu
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Li-Na Lu
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China
| | - Kai-Rong Zheng
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
| | - Hai-Dong Zou
- Department of Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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13
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Ming S, Xie K, Lei X, Yang Y, Zhao Z, Li S, Jin X, Lei B. Evaluation of a novel artificial intelligence-based screening system for diabetic retinopathy in community of China: a real-world study. Int Ophthalmol 2021; 41:1291-1299. [PMID: 33389425 DOI: 10.1007/s10792-020-01685-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the performance of an AI-based diabetic retinopathy (DR) grading model in real-world community clinical setting. METHODS Participants with diabetes on record in the chosen community were recruited by health care staffs in a primary clinic of Zhengzhou city, China. Retinal images were prospectively collected during December 2018 and April 2019 based on intent-to-screen principle. A pre-validated AI system based on deep learning algorithm was deployed to screen DR graded according to the International Clinical Diabetic Retinopathy scale. Kappa value of DR severity, the sensitivity, specificity of detecting referable DR (RDR) and any DR were generated based on the standard of the majority manual grading decision of a retina specialist panel. RESULTS Of the 193 eligible participants, 173 (89.6%) were readable with at least one eye image. Mean [SD] age was 69.3 (9.0) years old. Total of 321 eyes (83.2%) were graded both by AI and the specialist panel. The κ value in eye image grading was 0.715. The sensitivity, specificity and area under curve for detection of RDR were 84.6% (95% CI: 54.6- 98.1%), 98.0% (95% CI: 94.3-99.6%) and 0.913 (95% CI: 0.797-1.000), respectively. For detection of any DR, the upper indicators were 90.0% (95% CI: 68.3-98.8), 96.6% (95% CI: 92.1-98.9) and 0.933 (95% CI: 0.933-1.000), respectively. CONCLUSION The AI system showed relatively good consistency with ophthalmologist diagnosis in DR grading, high specificity and acceptable sensitivity for identifying RDR and any DR. TRANSLATIONAL RELEVANCE It is feasible to apply AI-based DR screening in community. PRECIS Deployed in community real-world clinic setting, AI-based DR screening system showed high specificity and acceptable sensitivity in identifying RDR and any DR. Good DR diagnostic consistency was found between AI and manual grading. These prospective evidences were essential for regulatory approval.
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Affiliation(s)
- Shuai Ming
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Kunpeng Xie
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Xiang Lei
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Yingrui Yang
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Zhaoxia Zhao
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Shuyin Li
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Xuemin Jin
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China
| | - Bo Lei
- Department of Ophthalmology, Clinical Research Center, Henan Eye Hospital, Henan Provincial People's Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, No.7 Weiwu Road, Jinshui District, Zhengzhou, 450003, China.
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Association between dietary antioxidants and risk for diabetic retinopathy in a Chinese population. Eye (Lond) 2020; 35:1977-1984. [PMID: 33009517 DOI: 10.1038/s41433-020-01208-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is related to oxidative stress and insufficient intake of dietary antioxidants may be associated with the onset and progression of DR. This study aimed to detect the association between main dietary antioxidants intake and the risk for DR. METHODS This is a cross-sectional study of a Chinese urban population. Four hundred and fifty-five subjects with type 2 diabetes were recruited and divided into diabetic patients without retinopathy (DWR) group and DR group based on their retinal status. CSMO (clinically significant macular oedema) was diagnosed by stereoscopic photography. Demographic and lifestyle characteristics were ascertained by questionnaire. General physical and ophthalmic examinations were completed for all subjects. Dietary antioxidants were assessed by 3-day food records. Subjects who have taken any type of vitamin supplements were excluded from the study. The association of dietary antioxidants with the risk for DR was analysed by logistic regression with adjustment of other factors. The dietary antioxidants levels of the CSMO subjects and non-CSMO subjects were compared using the Wilcoxon rank sum test. RESULTS One hundred and nineteen subjects in DR group and 336 subjects in DWR group participated in the study. Only ten DR subjects had CSMO. The results showed that higher vitamin E (OR (95% CI):0.97 (0.95, 1.00), P = 0.036) and selenium (OR (95% CI):0.98 (0.96, 1.00), P = 0.017) intake appear to be the protective factors of DR. The dietary antioxidants levels of CSMO and non-CSMO subjects had no statistical differences (P > 0.05). CONCLUSIONS Dietary antioxidants intake, particularly vitamin E and selenium, were observed to have protective effects on DR.
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Lin Z, Li D, Zhai G, Wang Y, Wen L, Ding XX, Wang FH, Dou Y, Xie C, Liang YB. High myopia is protective against diabetic retinopathy via thinning retinal vein: A report from Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). Diab Vasc Dis Res 2020; 17:1479164120940988. [PMID: 32686483 PMCID: PMC7510364 DOI: 10.1177/1479164120940988] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To investigate the association between high myopia and diabetic retinopathy, and its possible mechanism, in a northeastern Chinese population with type 2 diabetic mellitus. METHODS Patients were included from Fushun Diabetic Retinopathy Cohort Study. High myopia was defined as spherical equivalent of autorefraction less than -5D. RESULTS A total of 1817 patients [688 (37.9%) diabetic retinopathy, 102 (5.6%) high myopia] were included. Compared to eyes without high myopia, the frequency of diabetic retinopathy and non-proliferative diabetic retinopathy was significantly less in eyes with high myopia (23.5% vs 38.7%, p = 0.002; 22.5% vs 35.3%, p = 0.005). Eyes with high myopia were less likely to have diabetic retinopathy (multivariate odds ratio, 95% confidence interval: 0.39, 0.22-0.68) or non-proliferative diabetic retinopathy (odds ratio, 95% confidence interval: 0.40, 0.23-0.70). High myopia was negatively associated with central retinal venular equivalent (multivariate β, 95% confidence interval: -37.1, -42.3 to -31.8, p < 0.001). Furthermore, central retinal venular equivalent (per 10 μm increase) had a significant association with diabetic retinopathy (odds ratio, 95% confidence interval: 1.24, 1.17-1.31) as well as non-proliferative diabetic retinopathy (odds ratio, 95% confidence interval: 1.24, 1.18-1.31). CONCLUSIONS High myopia was negatively associated with both diabetic retinopathy and non-proliferative diabetic retinopathy in this northeastern Chinese population. This protective effect may have been partially achieved via thinning retinal veins.
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Affiliation(s)
- Zhong Lin
- School of Ophthalmology & Optometry, Wenzhou Medical University, Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dong Li
- Fushun Eye Hospital, Liaoning, Province, China
| | - Gang Zhai
- Fushun Eye Hospital, Liaoning, Province, China
- Gang Zhai, Fushun Eye Hospital, No. 1 Hu Po Quan Street, Xin Fu District, Fushun, Liaoning 113006, China.
| | - Yu Wang
- Fushun Eye Hospital, Liaoning, Province, China
| | - Liang Wen
- Fushun Eye Hospital, Liaoning, Province, China
| | | | - Feng Hua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
| | - Yu Dou
- Fushun Eye Hospital, Liaoning, Province, China
| | - Cong Xie
- Fushun Eye Hospital, Liaoning, Province, China
| | - Yuan Bo Liang
- School of Ophthalmology & Optometry, Wenzhou Medical University, Eye Hospital of Wenzhou Medical University, Wenzhou, China
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16
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Design, methodology, and preliminary results of the follow-up of a population-based cohort study in rural area of northern China: Handan Eye Study. Chin Med J (Engl) 2020; 132:2157-2167. [PMID: 31490265 PMCID: PMC6797155 DOI: 10.1097/cm9.0000000000000418] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Handan Eye Study (HES), a large population-based cohort study in rural area of northern China, was one of the few studies focusing on the major eye diseases of rural Chinese population. The aim of this study was to introduce the design, methodology and to assess the data quality of the follow-up phase of HES. Methods: All participants were recruited in Yongnian county of Handan city between 2012 and 2013. Main outcomes were measured by visual quality scales and ocular examinations. We performed the Chi-square test to make comparison of categorical data among groups, One-way analysis of variance and Kruskal-Wallis test was applied to make comparison of continuous data among groups, a post-hoc test was done to make further pairwise comparison. Inter-class correlation coefficients (ICCs) and Kappa coefficients were used to evaluate the consistency between different operators. Logistic regression was used to explore the influence factors of death, odds ratio (OR) and 95% confidence interval (CI) were used to estimate the effect size of each influence factor. Results: The follow-up rate was 85.3%. Subjects were classified into three groups: the follow-up group (n = 5394), the loss to follow-up group (n = 929), and the dead group (n = 507), comparison of their baseline information was done. Compared with the other two groups, age of the dead group (66.52 ± 10.31 years) was the oldest (Z = 651.293, P < 0.001), male proportion was the highest (59.0%) (χ2 = 42.351, P < 0.001), only 65.9% of the dead finished middle school education (Z = 205.354, P < 0.001). The marriage percentage, body mass index (BMI), best-corrected visual acuity (BCVA), and intra-ocular pressure of the dead group was the lowest either. Spherical equivalent error (SER) of the dead group was the highest. Besides, history of smoking, hypertension, diabetes, and heart disease were more common in the dead group. Multivariate analysis showed that age (OR = 1.901, 95% CI: 1.074–1.108), gender (OR = 0.317, 95% CI: 0.224–0.448), and BCVA (OR = 0.282, 95% CI: 0.158–0.503) were associated with death. While between the follow-up group and the loss to follow-up group, there was only difference on age, gender, BMI, systolic blood pressure and SER. The Cronbach coefficients of all scales used in the follow-up were ≥0.63 and the cumulative variances were ≥0.61, indicating good reliability and validity. The ICCs and Kappa coefficients between different operators were ≥0.69. Conclusions: HES has a high follow-up rate and a low risk of loss to follow-up bias. Age, gender, and BCVA are influence factors of death. Specifically, male subjects are at a higher risk of death than female, age is a risk factor of death while BCVA is a protective factor for death.
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Hypertension, blood pressure control and diabetic retinopathy in a large population-based study. PLoS One 2020; 15:e0229665. [PMID: 32134944 PMCID: PMC7058315 DOI: 10.1371/journal.pone.0229665] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/11/2020] [Indexed: 01/22/2023] Open
Abstract
Background Clinical trials have shown beneficial effects of blood pressure (BP) control in reducing the risk of diabetic retinopathy (DR). However, association between BP control and DR in population-based studies is not clear. We aimed to examine the association of hypertension and BP control with DR. Methods We analysed data from a population-based cross-sectional study of Chinese, Malay and Indians adults with diabetes and hypertension (2004–2011, n = 2189, aged 40–80 years) in Singapore. DR severity was assessed from retinal photographs and graded for any- and vision-threatening DR (VTDR) using the modified Airlie House classification. Hypertension status was classified into (1) good control: on treatment (SBP < 130 and DBP < 80 mm Hg), (2) moderate control: on treatment, with BP levels other than group 1 and 3, (3) poor control: on treatment (SBP ≥140 and DBP ≥ 90 mm Hg), (4) untreated hypertension, any BP level. SBP, DBP and pulse pressure (PP) were analyzed as categories and as continuous variables. The association between BP and DR was assessed using multivariable logistic regression models. Results The prevalence of any-DR and VTDR in the study population was 33.8% and 9.0% respectively. Both poorly controlled and untreated hypertension were significantly associated with any-DR with odds ratio (OR) (95% confidence interval [CI]) of 1.97 (1.39–2.83), and 2.01 [1.34–3.05]. Among BP components, SBP and PP were associated with both any-DR and VTDR with OR (95% CI) of 1.45 (1.28–1.65) and 1.61 (1.41–1.84) for any-DR, and 1.44 (1.19–1.76) and 1.67 (1.37–2.06) for VTDR. Conclusion In a population-based sample of Asian adults with diabetes and hypertension, treated but poorly controlled as well as untreated hypertension were significantly associated with any-DR. Among the BP components, higher SBP and PP levels were associated with both any-DR and VTDR. Further longitudinal studies are necessary to confirm our findings.
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Jin P, Li Z, Xu X, He J, Chen J, Xu X, Du X, Bai X, Zhang B, He X, Lu L, Zhu J, Shi Y, Zou H. Analysis of association between common variants of uncoupling proteins genes and diabetic retinopathy in a Chinese population. BMC MEDICAL GENETICS 2020; 21:25. [PMID: 32028915 PMCID: PMC7006419 DOI: 10.1186/s12881-020-0956-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 01/20/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to explore the association between diabetic retinopathy (DR) and the variants of uncoupling proteins (UCPs) genes in a Chinese population of type 2 diabetes, in total and in patients of different glycemic status separately. METHODS This case-control study included a total of 3107 participants from two datasets, among which 662 were DR patients (21.31%). Eighteen tag single nucleotide polymorphisms (SNPs) of UCP1, UCP2, and UCP3 were selected as genetic markers. TaqMan probes, Sequenom MassARRAY MALDI-TOF mass spectrometry platform and Affymetrix Genome-Wide Human SNP Array were used for genotyping. Online SHEsis software was used for association analysis. Bonferroni correction was used for multiple comparisons correction. RESULTS Three SNPs of UCP1: rs7688743 (A allele, OR = 1.192, p = 0.013), rs3811787 (T allele, OR = 0.863, p = 0.023), and rs10011540 (G allele, OR = 1.368, p = 0.004) showed association with DR after the adjustment of glucose, but only rs10011540 was marginally significantly associated with DR when Bonferroni correction was strictly applied (padj = 0.048). In patients with uncontrolled glucose, rs7688743 (A allele, p = 0.012, OR = 1.309), rs10011540 (G allele, p = 0.033, OR = 1.432), and rs3811787 (T allele, p = 0.022, OR = 0.811) were associated with DR, while in participants with well controlled glucose, the rs2734827 of UCP3 was associated with DR (A allele, p = 0.017, OR = 0.532). Rs3811787 of UCP1 showed a protective effect to sight threatening DR (T allele, p = 0.007, OR = 0.490), and the association existed after the adjustment for environmental factors and the correction. In patients with uncontrolled glucose, the rs3811787 of UCP1 (T allele, p = 0.017, OR = 0.467) and the rs591758 of UCP3 (C allele, p = 0.026, OR = 0.103) were associated with STDR. While in those with well controlled glucose, only the rs7688743 of UCP1 showed a protective effect (A allele, p = 0.024, OR = 0.049). None of the associations remain significant when Bonferroni correction was strictly applied (all p < 0.05). CONCLUSIONS The rs10011540 and rs3811787 of the UCP1 gene was marginally significantly associated with DR in Chinese type 2 diabetes patients. There might be different mechanisms of DR development in patients with different glycemic status.
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Affiliation(s)
- Peiyao Jin
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named"Shanghai First People's Hospital"), Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, No.100 Haining Road, Shanghai, 20080, China
| | - Zhiqiang Li
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xian Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named"Shanghai First People's Hospital"), Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, No.100 Haining Road, Shanghai, 20080, China
| | - Jiangnan He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Jianhua Chen
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named"Shanghai First People's Hospital"), Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, No.100 Haining Road, Shanghai, 20080, China.,Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Xuan Du
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Xuelin Bai
- Xinjing Community Health Service Centre, Shanghai, 200335, China
| | - Bo Zhang
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Xiangui He
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Lina Lu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Jianfeng Zhu
- Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China
| | - Yongyong Shi
- Bio-X Institutes, Key Laboratory for the Genetics of Developmental and Neuropsychiatric Disorders (Ministry of Education), Shanghai Jiao Tong University, Shanghai, 200030, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine (originally named"Shanghai First People's Hospital"), Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, National Clinical Research Center for Eye Diseases, No.100 Haining Road, Shanghai, 20080, China. .,Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai, 200040, China.
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Wang Y, Lin Z, Wen L, Rong SS, Ding XX, Li D, Feng KM, Wang FH, Liang YB, Zhai G. Rationale, Design, Methodology and Baseline Data of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT). Ophthalmic Epidemiol 2019; 27:73-82. [PMID: 31722595 DOI: 10.1080/09286586.2019.1680702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To describe the rationale, design, methodology and baseline characteristics of Fushun Diabetic Retinopathy Cohort Study (FS-DIRECT), a community-based prospective cohort study in patients with type 2 diabetes mellitus (T2DM) living in northeast China.Methods: Patients with T2DM, aged 30 years and above from communities of Fushun city, Liaoning province, China, were recruited. The presence and severity of the diabetic retinopathy (DR) were determined by a modified Early Treatment Diabetic Retinopathy Study (ETDRS) retinopathy scale of 6 fields fundus photographs. Detailed ocular examinations and questionnaires were collated, in addition to blood and urine sample collection.Results: Of the 2224 subjects eligible for the FS-DIRECT, 2033 (91.4%) participated in the study. The majority of participants were female (58.9%), the average age was 62.1 ± 9.1 years. The overall prevalence rates of DR, non-proliferative DR, proliferative DR, diabetic macular edema, and vision-threatening retinopathy were 44.3%, 40.0%, 4.3%, 15.2%, and 12.3%, respectively. Compared to the patients without DR, patients with DR had lower income, an earlier onset of diabetes, a longer duration of diabetes, higher proportion of insulin use, higher fasting plasma glucose, HbA1c, systolic blood pressure, total cholesterol and high density lipoprotein, as well as a higher level of urine protein (all P < .05).Conclusion: The baseline data of FS-DIRECT showed a high prevalence of DR in a community of northeast China. Further investigation will provide key information about the risk factors, impact, and trends of DR in this region.
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Affiliation(s)
- Yu Wang
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Zhong Lin
- School of Ophthalmology & Optometry, Wenzhou Medical University, Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Wen
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Shi Song Rong
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | | | - Dong Li
- Fushun Eye Hospital, Fushun, Liaoning, China
| | - Ke Mi Feng
- School of Ophthalmology & Optometry, Wenzhou Medical University, Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Hua Wang
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Ophthalmology & Visual Science Key Lab, Beijing, China
| | - Yuan Bo Liang
- School of Ophthalmology & Optometry, Wenzhou Medical University, Eye Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gang Zhai
- Fushun Eye Hospital, Fushun, Liaoning, China
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Cui Y, Zhang M, Zhang L, Zhang L, Kuang J, Zhang G, Liu Q, Guo H, Meng Q. Prevalence and risk factors for diabetic retinopathy in a cross-sectional population-based study from rural southern China: Dongguan Eye Study. BMJ Open 2019; 9:e023586. [PMID: 31530585 PMCID: PMC6756414 DOI: 10.1136/bmjopen-2018-023586] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RESEARCH QUESTION The current population-based study aimed to investigate the prevalence of diabetic retinopathy (DR) and risk factors among residents over 40 years old in the rural area of Dongguan, southern China. STUDY DESIGN The Dongguan Eye Study was a population-based study from September 2011 to February 2012. SETTING The area was set in the rural area of Dongguan, southern China. PARTICIPANTS Adult rural population aged 40 or older. INTERVENTION Participants underwent haematological, physical, ophthalmic examinations and completed a questionnaire regarding lifestyles and systemic medical conditions. PRIMARY AND SECONDARY OUTCOME MEASURES The frequency and risk factors of visual impairment and the major vision-threatening eye diseases. RESULTS Of the 8952 Han Chinese, 1500 were diagnosed with type 2 diabetes mellitus (T2DM) with an average age of 59.5±11.1 years, and 1310 participants with fundus photography results were analysed. Standardised prevalence rate of DR was 18.2% for all patients with diabetes, 32.8% for the patients with previously diagnosed diabetes and 12.6% for newly diagnosed patients with T2DM. The prevalence rate of male DR was significantly higher than that of female DR (23.0% vs 14.1%, p<0.001). No significant difference was found in age-specific prevalence of DR. In diabetic patients, the prevalence rates of vision-threatening diabetic retinopathy, diabetic macular oedema and clinically significant macular oedema were 2.5%, 2.8% and 0.9%, respectively. Male gender, higher education level, longer duration of diabetes mellitus (DM), higher systolic blood pressure and glycosylated haemoglobin were independent risk factors for DR development in patients with diabetes. CONCLUSION A relatively lower prevalence of DR was found among the participants with T2DM in residents over 40 years in the rural area of southern China. Thus, an ophthalmic examination is recommended, especially for individuals with DM and DR risk factors. There is a need to increase awareness and education on DM and DR, especially in subjects with DR risk factors to reduce the incidence of DR and macular oedema.
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Affiliation(s)
- Ying Cui
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Min Zhang
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, China
| | - Liang Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lixin Zhang
- Department of Ophthalmology, Hengli Hospital, Dongguan, China
| | - Jian Kuang
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guanrong Zhang
- Information and Statistics Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qingyang Liu
- Department of Ophthalmology, Dongguan People's Hospital, Dongguan, China
| | - Haike Guo
- Department of Ophthalmology, Shanghai Peace Eye Hospital, Shanghai, China
| | - Qianli Meng
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Annani-Akollor ME, Addai-Mensah O, Fondjo LA, Sallah L, Owiredu EW, Acheampong E, Akamugri S. Predominant Complications of Type 2 Diabetes in Kumasi: A 4-Year Retrospective Cross-Sectional Study at a Teaching Hospital in Ghana. ACTA ACUST UNITED AC 2019; 55:medicina55050125. [PMID: 31075814 PMCID: PMC6572706 DOI: 10.3390/medicina55050125] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/19/2019] [Accepted: 05/07/2019] [Indexed: 12/13/2022]
Abstract
Background and objectives: Diabetes mellitus type 2 (T2DM) has been associated with several microvascular and macrovascular complications. However, studies regarding the predominant complications of T2DM in Ghana have not been conducted. This study evaluated the prevalence and predominant complications of T2DM and assessed the sociodemographic factors associated with the development of diabetes-related complications in Kumasi, Ghana. Materials and Methods: This was a retrospective cross-sectional study conducted at Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. A total of 1600 Ghanaian T2DM adults were included in this study. Patients' clinical data from 2012 to 2016 were retrieved from the hospital's archive. Results: The prevalence of macrovascular and microvascular complications of T2DM was 31.8% and 35.3% respectively. The prevalence of neuropathy, nephropathy, retinopathy, sexual dysfunction, diabetic keto-acidosis (DKA), and hypoglycemia were 20.8%, 12.5%, 6.5%, 3.8%, 2.0%, and 0.8% respectively. Sexual dysfunction was significantly associated with the male gender compared to females. Being employed: Informal (aOR = 0.479, p < 0.0001), and Formal (aOR = 0.475, p = 0.0008) was associated with lower age- and sex-adjusted odds of developing T2DM-related complications while having T2DM for 5-10 years (aOR = 1.550, p = 0.0009) and more than 10 years (aOR = 2.755, p < 0.0001) was associated with increased odds of developing complications. Conclusions: Microvascular complication is the most predominant among T2DM in Kumasi, Ghana. The most prevalent T2DM-related microvascular complication in Kumasi, Ghana is neuropathy. Sexual dysfunction is associated with male compared to female T2DM patients. Being employed reduces the chance of developing T2DM-related complications while increasing DM duration increases the risk of complications.
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Affiliation(s)
- Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
| | - Otchere Addai-Mensah
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
| | - Linda Ahenkorah Fondjo
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
| | - Lorraine Sallah
- Department of Physiology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
- School of Medical and Health Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
| | - Solomon Akamugri
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, PMB, UPO, Kumasi 00233, Ghana.
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Yang QH, Zhang Y, Zhang XM, Li XR. Prevalence of diabetic retinopathy, proliferative diabetic retinopathy and non-proliferative diabetic retinopathy in Asian T2DM patients: a systematic review and Meta-analysis. Int J Ophthalmol 2019; 12:302-311. [PMID: 30809489 DOI: 10.18240/ijo.2019.02.19] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/07/2018] [Indexed: 12/19/2022] Open
Abstract
AIM To investigate the pooled prevalence of diabetic retinopathy (DR), proliferative DR (PDR) and nonproliferative DR (NPDR) in Asian type 2 diabetes mellitus (T2DM) patients. METHODS We performed a systematic search online search using PubMed, EMBASE, Web of Science, the Cochrane Library, and China WeiPu Library to identify eligible studies that reported the prevalence of DR, PDR and NPDR in Asian T2DM patients. Effect size (ES) with 95% confidence interval (CI) was used to evaluate the prevalence of DR, PDR and NPDR in Asian T2DM patients, respectively. RESULTS There were 41 references and 48 995 T2DM patients involved in this study. The prevalence of DR, PDR, and NPDR was 28%, 6%, and 27% in T2DM patients, respectively; while the prevalence of PDR and NPDR in DR patients was 17% and 83%, respectively. Subgroup analysis showed that prevalence of DR in T2DM patients from Singaporean, Indian, South Korean, Malaysian, Asian, and Chinese was 33%, 42%, 16%, 35%, 21% and 25%, respectively. In T2DM patients with NPDR from Indian, South Korean, Malaysian, Asian, Chinese, higher prevalence was found than that in PDR patients (45% vs 17%, 13% vs 3%, 30% vs 5%, 23% vs 2% and 22% vs 3%), as well as in DR patients (74% vs 26%, 81% vs 19%, 86% vs 14%, 92% vs 8% and 85% vs 15%). The prevalence of PDR in T2DM from India was higher than patients from other locations of Asia, and the same results were also observed in NPDR patients. CONCLUSION In either T2DM Asian patients or DR patients, NPDR is more common than PDR. Based on our results, we should pay more attention to NPDR screening and management in T2DM patients, and we also recommend suitable interventions to prevent its progression.
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Affiliation(s)
- Qian-Hui Yang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Yan Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Min Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
| | - Xiao-Rong Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute & Tianjin Medical University School of Optometry and Ophthalmology, Tianjin 300384, China
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Efficacy and safety of ranibizumab 0.5 mg in Chinese patients with visual impairment due to diabetic macular edema: results from the 12-month REFINE study. Graefes Arch Clin Exp Ophthalmol 2019; 257:529-541. [PMID: 30645696 DOI: 10.1007/s00417-018-04213-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To demonstrate the efficacy and safety of ranibizumab 0.5 mg pro re nata (PRN) versus laser photocoagulation for the treatment of Chinese patients with visual impairment due to diabetic macular edema (DME). METHODS REFINE was a phase III, 12-month, double-masked, multicenter, laser-controlled study in patients (aged ≥ 18 years) with DME. Patients were randomized 4:1 to receive either ranibizumab 0.5 mg or laser dosing regimen. Efficacy was evaluated as mean average change in best-corrected visual acuity (BCVA) from Months 1 to 12 versus baseline (primary endpoint), anatomical outcomes, treatment exposure, and safety were also assessed. RESULTS Ranibizumab was statistically superior (p < 0.001) to laser treatment, with a mean average BCVA gain of 6.8 letters (ranibizumab) over 12 months versus 1.1 letters (laser). At Month 12, mean BCVA gain was 7.8 letters (ranibizumab) and 2.5 letters (laser) from baseline. Patients in the ranibizumab arm received a mean number of 7.9 intravitreal injections, whereas those in the laser arm received a mean of 2.1 treatments. There were no new safety signals. CONCLUSION Ranibizumab 0.5 mg PRN demonstrated a statistically significant and clinically meaningful treatment effect versus laser and was well tolerated in Chinese patients with visual impairment due to DME over 12 months.
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Zhang Y, Zhao L, Li H, Wang Y. Risk factors for hypertensive retinopathy in a Chinese population with hypertension: The Beijing Eye study. Exp Ther Med 2019; 17:453-458. [PMID: 30651821 PMCID: PMC6307479 DOI: 10.3892/etm.2018.6967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Hypertensive retinopathy (HRP) is a clinical feature and systemic manifestation of hypertension. There have been few reports on the risk factors for hypertensive retinopathy in China. The aim of the present study was to describe risk factors associated with HRP in a population-based sample of Chinese patients with hypertension in Beijing. The clinical data of 228 hypertensive patients was retrospectively studied, including 112 patients with retinopathy for the HRP group and 116 patients without retinopathy for the NO-HRP group. Basic clinical data and plasma clinical indicators of the two groups were compared. Logistic regression models were used to assess risk factors associated with HRP. Duration of hypertension, smoking habits, family history of hypertension, plasma level of endothelin-1 (ET-1) and systolic and diastolic blood pressure were significantly increased in the HRP group compared with the NO-HRP group (P<0.05). No significant differences were identified between the two groups for other factors. Logistic regression models indicated that hypertension duration (P<0.001, 95% CI: 0.962-0.988) and ET-1 level (P<0.001, 95% CI: 1.144-1.278) were significantly associated with HRP. The diagnostic threshold of ET-1 to diagnosis HRP was 43.5 ng/l. Of the factors studied, longer hypertension duration and elevated ET-1 level were identified to be risk factors for HRP in patients with hypertension from Beijing. Detecting the plasma level of ET-1 in patients with hypertension may be a useful diagnostic indicator for HRP.
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Affiliation(s)
- Youjing Zhang
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Lu Zhao
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
| | - Yanling Wang
- Department of Ophthalmology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, P.R. China
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Xia F, Sun JJ, Jiang YQ, Li CF. MicroRNA-384-3p inhibits retinal neovascularization through targeting hexokinase 2 in mice with diabetic retinopathy. J Cell Physiol 2018; 234:721-730. [PMID: 30191948 DOI: 10.1002/jcp.26871] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/23/2018] [Indexed: 01/18/2023]
Abstract
Diabetic retinopathy (DR) presents a microvascular complication of diabetes, which may contribute to visual impairment. The treatment of DR is still controversial. Accumulating studies have reported the role of microRNAs (miRs) in DR. This study aims to explore the functions of microRNA-384-3p (miR-384-3p) in retinal neovascularization by targeting hexokinase 2 (HK2) in mice with DR. A total of 43 C57BL/6 male mice were selected and divided into normal ( n = 16) and DR ( n = 27) groups. Retinal microvascular endothelial cells (RMECs) were collected from the normal and DR mice and mainly treated with a miR-384-3p mimic, a miR-384-3p inhibitor, small interfering RNA (siRNA) against HK2 and HK2 overexpression plasmids to understand the underlying regulatory mechanisms of miR-384-3p. The relationship between miR-384-3p and HK2 was determined by dual-luciferase reporter assay. The miR-384-3p expression and the mRNA and the protein expressions of HK2 and CD31 in retinal tissues and cells were evaluated using reverse transcription quantitative polymerase chain reaction (RT-qPCR) and western blot assay. Cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Tube formation was observed by conducting a tube formation experiment. HK2 is a target gene of miR-384-3p. The DR mice showed higher expression of HK2 and CD31 but lower expression of miR-384-3p. The miR-384-3p mimic and siRNA-HK2 reduced the expression of HK2, decreased cell proliferation and tube formation of RMECs, whereas the miR-384-3p inhibitor could reverse these trends. Our study demonstrates that overexpression of miR-384-3p inhibits retinal neovascularization in DR mice via inhibition of HK2.
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Affiliation(s)
- Fei Xia
- Department of Ophthalmology, The Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Juan-Juan Sun
- Department of Ophthalmology, The Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Ya-Qin Jiang
- Department of Ophthalmology, Weifang Eye Hospital, Weifang, China
| | - Cheng-Fang Li
- Department of Ophthalmology, The Affiliated Qingdao Hiser Hospital of Qingdao University (Qingdao Hospital of Traditional Chinese Medicine), Qingdao, China
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Cui J, Ren JP, Chen DN, Xin Z, Yuan MX, Xu J, You QS, Yang JK. Prevalence and associated factors of diabetic retinopathy in Beijing, China: a cross-sectional study. BMJ Open 2017; 7:e015473. [PMID: 28855199 PMCID: PMC5724071 DOI: 10.1136/bmjopen-2016-015473] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The study aimed to determine the exact risk factors for diabetic retinopathy (DR) in the Chinese population using a cohort of 17 985 individuals from Beijing, China. DESIGN Cross-sectional study. SETTING A hospital. PARTICIPANTS 17 985 individuals from Beijing, China. PRIMARY AND SECONDARY OUTCOME MEASURES This was a cross-sectional study of permanent residents from the Changping area (Beijing, China) recruited from July 2010 to March 2011 and from March 2014 to February 2015 during a routine health examination at the Tongren Hospital of Beijing. Eye examinations were conducted by experienced ophthalmologists. Medical history, height, weight, body mass index (BMI) and blood pressure were recorded. Routine laboratory examinations were performed. RESULTS The prevalence of DR was 1.5% in the general study population and 8.1% among individuals with diabetes. Compared with the non-DR group, individuals in the DR group in the diabetes population had longer disease duration, higher systolic blood pressure (SBP), fasting plasma glucose (FPG) and uric acid (UA) (in men) and lower UA (in women) (all p<0.05). The multivariate analysis showed that disease duration (p<0.001), BMI (p=0.046), SBP (p=0.012), creatinine clearance rate (CCR) (p=0.014), UA (p=0.018) and FPG (p<0.001) were independently associated with DR in patients with diabetes. CONCLUSION The prevalence of DR was 8.1% among patients with diabetes. Disease duration, BMI, SBP, CCR, UA and FPG were independently associated with DR.
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Affiliation(s)
- Jing Cui
- Department of Physical Examination, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ji-Ping Ren
- Department of Physical Examination, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Dong-Ning Chen
- Department of Physical Examination, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ming-Xia Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Qi-Sheng You
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Zhang G, Chen H, Chen W, Zhang M. Prevalence and risk factors for diabetic retinopathy in China: a multi-hospital-based cross-sectional study. Br J Ophthalmol 2017; 101:1591-1595. [PMID: 28855195 PMCID: PMC5754882 DOI: 10.1136/bjophthalmol-2017-310316] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 01/19/2023]
Abstract
Purpose To determine the prevalence and risk factors for diabetic retinopathy (DR) and sight-threatening diabetic retinopathy (STDR) in a multi-hospital-based DR screening programme among patients with diabetes in China, the Lifeline Express Diabetic Retinopathy Screening Program. Methods Patients with diabetes in eight hospitals across mainland China (both southern and northern) from January 2014 to July 2016 were recruited in this programme. All participants underwent a standardised interview and examinations and received digital fundus photography. DR severity was graded from retinal fundus photographs by retina specialists in the reading centre of Joint Shantou International Eye Center, according to the grading standards of the English National Screening Programme. STDR was defined as the presence of preproliferative DR (R2), proliferative DR (R3) and/or maculopathy (M1). Results 16 305 patients with diabetes were screened for DR in total. Fundus photographs were gradable for 15 078 patients (92.5%). The age–gender-standardised prevalence of any DR and STDR was 27.9% (95% CI, 27.2% to 28.6%) and 12.6% (95% CI, 12.1% to 13.1%), respectively. In the multiple logistic regression analysis, younger age (OR, 0.967), longer duration of diabetes (OR, 1.093), higher haemoglobin A1c (OR, 1.115), higher fasting plasma glucose (OR, 1.074), higher systolic blood pressure (OR, 1.014), faster heart rate (OR, 1.010), higher low-density lipoprotein (OR, 1.149), lower triglycerides (OR, 0.975), higher blood urea nitrogen (BUN) (OR, 1.012) and elevated serum creatinine level (OR, 1.003) were associated with the presence of DR. Similar risk factors, except for BUN and triglycerides, were found for STDR. Conclusions The prevalence of DR and STDR in diabetes was 27.9% and 12.6%, respectively in this multi-hospital-based population across China. Compared with Western population with diabetes, similar risk factors for DR and STDR were found in Chinese patients with diabetes.
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Affiliation(s)
- Guihua Zhang
- Department of Ophthalmology, The Joint Shantou International Eye Center (JSIEC) of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Haoyu Chen
- Department of Ophthalmology, The Joint Shantou International Eye Center (JSIEC) of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Weiqi Chen
- Department of Ophthalmology, The Joint Shantou International Eye Center (JSIEC) of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
| | - Mingzhi Zhang
- Department of Ophthalmology, The Joint Shantou International Eye Center (JSIEC) of Shantou University and The Chinese University of Hong Kong, Shantou, Guangdong, China
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Elwali ES, Almobarak AO, Hassan MA, Mahmooud AA, Awadalla H, Ahmed MH. Frequency of diabetic retinopathy and associated risk factors in Khartoum, Sudan: population based study. Int J Ophthalmol 2017; 10:948-954. [PMID: 28730087 DOI: 10.18240/ijo.2017.06.18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 03/30/2017] [Indexed: 02/02/2023] Open
Abstract
AIM To assess the frequency and associated risk factors of diabetic retinopathy among Sudanese individuals with diabetes attending Makka Eye complex in Khartoum, Sudan. METHODS The cross sectional hospital based study recruited 316 individuals with diabetes from Makkah Eye Complex Retina Clinic. Standard questionnaire was used to collect demographic data, medical history and life style characteristics. Blood samples were taken to measure HbA1c and lipid profile. Fundus and slit lamp examination were performed for screening of diabetic retinopathy. RESULTS Among 316 participants, 187 (59.2%) were males and 129 (40.8%) were females. The mean age of participants was 58.7±10.5y. The overall frequency of retinopathy was 261 (82.6%). The percentages of the total participants with proliferative diabetic retinopathy (PDR) were 126 (39.9%) and non-proliferative diabetic retinopathy (NPDR) were 135 (42.7%). Importantly, duration of diabetes mellitus (DM) (72.2% of more than 10y), being on oral hypoglycaemic drugs (versus insulin), and hypertension were all significant risk factors for diabetic retinopathy (P=0.00, 0.01 and 0.00 respectively). Complications of diabetes like diabetic foot (17.7%), history of amputation (6.7%) and clinically significant macular edema (CSME) (47.4%) of the eyes were all significant risk factors (P<0.05). Logistic regression analysis showed that duration of diabetes, hypertension and CSME were found to be absolute risk factors (P=0.007, 0.003 and 0.000 respectively). Duration of DM of more than 10y have more than double risk (OR=2.8), while having hypertension triples the risk of retinopathy (OR=3.1). CONCLUSION High rates of diabetic retinopathy are noted among individuals with diabetes attending Makkah Eye hospital in capital Khartoum. Urgent strategies are needed to monitor and treat hypertension and optimize diabetes control in individuals with diabetes. More investment in diabetes services is urgently needed.
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Affiliation(s)
- Einas S Elwali
- Public and Tropical Heath Program, Graduate College, University of Medical Sciences and Technology, Khartoum, Sudan
| | - Ahmed O Almobarak
- Department of Pathology, Faculty of Medicine, University of Medical Sciences and Technology, Khartoum, Sudan
| | | | | | - Heitham Awadalla
- Department of Community Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohamed H Ahmed
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes, Buckinghamshire MK 6 5LD, UK
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Sunita M, Singh AK, Rogye A, Sonawane M, Gaonkar R, Srinivasan R, Natarajan S, Stevens FCJ, Scherpbier AJJA, Kumaramanickavel G, McCarty C. Prevalence of Diabetic Retinopathy in Urban Slums: The Aditya Jyot Diabetic Retinopathy in Urban Mumbai Slums Study—Report 2. Ophthalmic Epidemiol 2017; 24:303-310. [DOI: 10.1080/09286586.2017.1290258] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohan Sunita
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Arvind Kumar Singh
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ashwini Rogye
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Manish Sonawane
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Ravina Gaonkar
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | - Radhika Srinivasan
- Aditya Jyot Foundation for Twinkling Little Eyes, Mumbai, Maharashtra, India
| | | | - Fred C. J. Stevens
- Department of Educational Development & Research, Maastricht University, Maastricht, the Netherlands
| | - A. J. J. A. Scherpbier
- Department of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Wang NL. Neurodegeneration in Diabetic Retinopathy: Current Concepts and Therapeutic Implications. Chin Med J (Engl) 2017; 129:3001-3003. [PMID: 27958234 PMCID: PMC5198537 DOI: 10.4103/0366-6999.195478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ning-Li Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100005, China
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Liu Y, Song Y, Tao L, Qiu W, Lv H, Jiang X, Zhang M, Li X. Prevalence of diabetic retinopathy among 13473 patients with diabetes mellitus in China: a cross-sectional epidemiological survey in six provinces. BMJ Open 2017; 7:e013199. [PMID: 28069622 PMCID: PMC5223683 DOI: 10.1136/bmjopen-2016-013199] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To describe the prevalence and severity of diabetic retinopathy (DR) and sight-threatening DR (STDR) among Chinese adults with diabetes. DESIGN, SETTING AND PARTICIPANTS A cross-sectional epidemiological survey across Mainland China (N=13 473). Participants were diagnosed with diabetes mellitus by physicians and transferred to our screening clinics (1/3 from hospital patients, 1/3 from city residents, the other 1/3 from rural residents). 2 fundus photographs were taken of each eye with a colourful, non-mydriatic and non-stereoscopic camera and were graded according to the UK guidelines. MAIN OUTCOMES AND MEASURES The prevalence and severity of DR and STDR. RESULTS Of the 13 473 participants with diabetes participating in the study, 4591 had DR and 1769 had STDR, for an overall prevalence of 34.08% (95% CI 33.28% to 34.88%) and 13.13% (95% CI 12.56% to 13.70%), respectively. Among these, gradable photographs were available for 12 780 participants (94.86%). Participants who were aged >65 years were less likely to suffer from DR or STDR (p<0.001; age distribution). No gender-related differences were present (p>0.05). Participants with STDR suffered from more severe visual impairment compared with those without STDR (p<0.001). The prevalence of DR and STDR in the northern region was higher than in the southern region (p<0.001). The prevalence of DR was closely related to duration of disease (OR 2.63; 95% CI 2.42 to 2.86; p<0.001) and diabetes onset age (OR 0.38; 95% CI 0.35 to 0.41; p<0.001). CONCLUSIONS The prevalence of DR and STDR in Mainland China appeared a little high, and varied according to area. Non-proliferative DR was more common, but STDR needed prompt treatment, especially in economically less developed areas. This study highlights the necessity for DR screening and treatment in Mainland China.
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Affiliation(s)
- Yan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Yifan Song
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Liyuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China
| | - Weiqiang Qiu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Huibin Lv
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Mingzhou Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
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She CY, Gu H, Xu J, Yang XF, Ren XT, Liu NP. Association of macular pigment optical density with early stage of non-proliferative diabetic retinopathy in Chinese patients with type 2 diabetes mellitus. Int J Ophthalmol 2016; 9:1433-1438. [PMID: 27803860 DOI: 10.18240/ijo.2016.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/13/2016] [Indexed: 12/17/2022] Open
Abstract
AIM To detect the association between macular pigment optical density (MPOD), which reflects the antioxidant ability of retina, and diabetic retinopathy (DR) and to investigate the correlated factors of MPOD. METHODS Totally 435 subjects of urban Chinese were recruited to the study and divided into 3 groups: non-diabetes mellitus controls (NDM), diabetic patients without retinopathy (DWR), and patients with early stage of non-proliferative diabetic retinopathy (DR). Demographic and lifestyle characteristics were ascertained by questionnaire. A food-frequency questionnaire, general physical and ophthalmic examinations were completed for all participants. MPOD was measured by heterochromatic flicker photometry. Foveal thickness was measured by optical coherence tomography. The difference of MPOD among 3 groups was analyzed by analysis of covariance. The correlation analyses of MPOD with the candidate influence factors were assessed using the generalized estimating equations (GEE) model. RESULTS Of the 435 participants, 34 could not perform the MPOD measurements. Final analysis included 401 subjects, including 48 were in DR group, 134 in DWR group, and 219 in NDM group. MPOD was not significantly different among DR (0.49±0.21), DWR (0.45±0.21), and NDM (0.49±0.17) groups (P=0.24) after adjustment for fasting plasma glycemia, central foveal thickness, green vegetables, Chinese wolfberry, carotene and vitamin E. For all the 401 participants included, MPOD was positively associated with central foveal thickness (E=0.0007, P=0.001), Chinese wolfberry (E=0.0345, P=0.01), and green vegetables (E=0.0596, P<0.001) intake. CONCLUSION The data suggest that MPOD level is not statistically significantly influenced by the onset of diabetes or early stage of DR in the studied population. MPOD level is positively associated with thicker central foveal thickness and higher intake of foods containing carotenoids.
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Affiliation(s)
- Chong-Yang She
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Hong Gu
- Department of Ophthalmology, Ningbo Medical Treatment Center Lihuili Hospital, Ningbo 315040, Zhejiang Province, China
| | - Jun Xu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
| | - Xiu-Fen Yang
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100730, China
| | - Xue-Tao Ren
- Department of Ophthalmology, Huaxin Hospital, Tsing Hua University, Beijing 100730, China
| | - Ning-Pu Liu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China
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Yan ZP, Ma JX. Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus. Int J Ophthalmol 2016; 9:1194-9. [PMID: 27588275 DOI: 10.18240/ijo.2016.08.17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/01/2015] [Indexed: 12/29/2022] Open
Abstract
AIM To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM). METHODS This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender. RESULTS Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95%CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95%CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95%CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%CI, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR. CONCLUSION Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR.
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Affiliation(s)
- Zhi-Peng Yan
- Department of Ophthalmology, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, Hebei Province, China
| | - Jing-Xue Ma
- Department of Ophthalmology, the Second Hospital of Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
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Jin P, Peng J, Zou H, Wang W, Fu J, Shen B, Bai X, Xu X, Zhang X. A five-year prospective study of diabetic retinopathy progression in chinese type 2 diabetes patients with "well-controlled" blood glucose. PLoS One 2015; 10:e0123449. [PMID: 25849536 PMCID: PMC4388440 DOI: 10.1371/journal.pone.0123449] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 03/03/2015] [Indexed: 12/31/2022] Open
Abstract
Purpose To determine the progression rate and risk factors for diabetic retinopathy (DR) in Chinese type 2 diabetic patients who have reached the target hemoglobin A1c (HbA1c) level recommended by the American Diabetes Association. Methods This was a 5-year community-based prospective study. The study population consisted of patients with type 2 diabetes with HbA1c less than 7.0%. Demographic information, systemic examination results and ophthalmological test results for each participant were collected. The outcome of this study was the progression of DR, which was defined as an increase in DR grade in one or both eyes at the final visit in comparison to the baseline status. The association between each potential risk factor and DR progression was studied. Results A total of 453 patients with HbA1c less than 7.0% were included in the study group. In 146 patients (32.22%), DR developed or progressed during the five-year follow-up. Baseline HbA1c level was the only independent risk factor for DR progression (p<0.01, OR = 2.84, 95%CI: 2.11~3.82). The logistic regression function suggested that the possibility of DR progression increased fastest when baseline HbA1c increased from 5.2% to 6.4%. The 5-year DR progression rate in patients with baseline HbA1c less than 5.2%, between 5.2% and 6.4%, and over 6.4% were 19.62%, 24.41%, and 76.83%, respectively. Conclusions To slow the progression of DR in Chinese patients with type 2 diabetes, more intensive glucose control is recommended.
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Affiliation(s)
- Peiyao Jin
- Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 20080, China
| | - Jinjuan Peng
- Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 20080, China
| | - Haidong Zou
- Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 20080, China
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai, 200040, China
- * E-mail:
| | - Weiwei Wang
- Beixinjing Community Health Service Center, Shanghai, China
| | - Jiong Fu
- Beixinjing Community Health Service Center, Shanghai, China
| | - Binjie Shen
- Beixinjing Community Health Service Center, Shanghai, China
| | - Xuelin Bai
- Beixinjing Community Health Service Center, Shanghai, China
| | - Xun Xu
- Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 20080, China
| | - Xi Zhang
- Department of Ophthalmology, Shanghai First People’s Hospital, Shanghai Jiao Tong University, Shanghai, 20080, China
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Abstract
PURPOSE To investigate the distribution of monochromatic aberrations in a rural Chinese adult population and the possible effect of aberrations on the development of refractive error. METHODS A total of 404 Chinese adults who grew up in rural Yongnian County, Handan City, Northern China, were included. Monochromatic aberrations of left eyes were measured using iTrace Dynamic Laser Refraction at 5.0-mm pupil size without cycloplegia. RESULTS Mean age of all participants was 49.9 ± 10.5 years (range, 31 to 86 years). Mean spherical equivalent was 0.22 ± 1.14 diopters (D) (range, -7.06 to +3.62 D). With age, the refraction demonstrated a significant hyperopic shift (r = 0.25, p < 0.01). Oblique trefoil (C3), vertical coma (C3), horizontal coma (C3), and spherical aberration (SA) (C4) significantly differed from zero (-0.065 ± 0.133 μm, -0.043 ± 0.161 μm, +0.070 ± 0.115 μm, and +0.058 ± 0.082 μm, respectively). Total root mean square values of higher-order aberrations (HOAs) were 0.296 ± 0.147 μm, with predominant ones of coma (0.180 ± 0.115 μm), trefoil (0.151 ± 0.116 μm), and SA (0.081 ± 0.060 μm). Root mean square values of total HOAs, coma, trefoil, SA, and third- to seventh-order aberrations significantly increased with age (p < 0.01). Total HOAs, SA, coma, and trefoil were not significantly different between hyperopic, emmetropic, and myopic eyes after adjusting for age (p = 0.26, 0.15, 0.24, and 0.28, respectively). Zernike coefficient of SA showed a significant difference between hyperopic (0.076 ± 0.086), emmetropic (0.056 ± 0.079), and myopic (0.028 ± 0.088) eyes (p = 0.00). CONCLUSIONS Ocular refraction in rural Chinese adults showed significantly hyperopic shift with age. Magnitudes of HOAs in rural Chinese adults were similar to that of other populations and significantly increased with age but showed no differences in myopic, emmetropic, and hyperopic adults. The existence of HOAs is not, in itself, sufficient to account for the myopia epidemic in China.
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Zhang HY, Wang JY, Ying GS, Shen LP, Zhang Z. Serum lipids and other risk factors for diabetic retinopathy in Chinese type 2 diabetic patients. J Zhejiang Univ Sci B 2014; 14:392-9. [PMID: 23645176 DOI: 10.1631/jzus.b1200237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the association of serum lipids and other risk factors with diabetic retinopathy (DR) in Chinese type 2 diabetic patients. METHODS Five hundred and twenty-three type 2 diabetic patients underwent ophthalmic examination by experienced retinal specialists to assess their DR. Serum lipids, including triglycerides, total cholesterol, high density lipoprotein cholesterol (HDLC), and low density lipoprotein cholesterol (LDLC), were measured using Roche automated clinical chemistry analyzers. The concentration of very low density lipoprotein cholesterol (VLDLC) was calculated based on total cholesterol, HDLC and LDLC. Hyperlipidemia was defined as a total cholesterol concentration of 6.2 mmol/L or higher or the use of lipid-lowering medications. The association of risk factors with any DR or proliferative diabetic retinopathy (PDR) was assessed using the odds ratio (OR) and its 95% confidence interval (CI), calculated from logistic regression models. RESULTS In multivariate logistic regression models, hyperlipidemia (OR=2.39, 95% CI: 1.02-5.66), higher VLDLC (OR=1.59, 95% CI: 1.14-2.23), and higher triglyceride (OR=1.18, 95% CI: 1.03-1.37) were associated with increased risk of DR. A longer diabetic duration was associated with increased risk of DR (P<0.0001) and PDR (P=0.002) in a dose-response manner. Higher systolic blood pressure (P=0.02) and higher serum creatinine (P=0.01) were independently associated with increased risk of DR, and female gender was associated with increased risk of PDR (P=0.03). CONCLUSIONS Among Chinese type 2 diabetic patients, hyperlipidemia, higher VLDLC, and higher triglyceride were independently associated with increased risk of DR, suggesting control of serum lipids may decrease the risk of DR.
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Affiliation(s)
- Hui-yan Zhang
- Hangzhou Vocational & Technical College, Hangzhou 310018, China
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Hussain S, Qamar MR, Iqbal MA, Ahmad A, Ullah E. Risk factors of retinopathy in type 2 diabetes mellitus at a tertiary care hospital, Bahawalpur Pakistan. Pak J Med Sci 2013; 29:536-9. [PMID: 24353572 PMCID: PMC3809270 DOI: 10.12669/pjms.292.3066] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 11/08/2012] [Accepted: 01/05/2013] [Indexed: 11/21/2022] Open
Abstract
Objectives: To find out the risk factors of diabetic retinopathy in type 2 diabetes mellitus. Methodology: It was a cross-sectional study involving 300 patients of type 2 diabetes. Clinical history, relevant examination including fundoscopy and lab investigations were done. Data was analysed with SPSS 17.0. T-test and chi square/Fischer exact were applied to determine significance. Results: Mean age of the patients was 49.04 ± 0.69 years with slight female predominance with male to female ratio of 3:4. Average duration of disease was 7.17 ± 0.38 years. Diabetic retinopathy was diagnosed in (74, 23.9%). Mean HbA1c was 8.15% in patients with retinopathy and 8.884% in those who had no retinopathy (p=0.08). However, duration of DM, age of patients, male gender, high total cholesterol, high LDL and microalbuminuria were significantly associated with the development of retinopathy. Conclusions: Diabetic retinopathy was found in 23.9% of type 2 diabetics. It was associated with duration of disease, age at presentation, male gender, high total cholesterol, high LDL and microalbuminuria. A single high level of HbA1c was not associated with retinopathy.
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Affiliation(s)
- Sadiq Hussain
- Sadiq Hussain, Department of Pathology, Quaid-e-Azam Medical College (QAMC), Bahawalpur, Pakistan
| | - Muhammad Rashad Qamar
- Muhammad Rashad Qamar, Department of Ophthalmology, Quaid-e-Azam Medical College (QAMC), Bahawalpur, Pakistan
| | - Muhammad Arshad Iqbal
- Muhammad Arshad Iqbal, Department of Pathology, Quaid-e-Azam Medical College (QAMC), Bahawalpur, Pakistan
| | - Ameer Ahmad
- Ameer Ahmad, Department of Paediatrics, Quaid-e-Azam Medical College (QAMC), Bahawalpur, Pakistan
| | - Ehsan Ullah
- Ehsan Ullah, Department of Pathology, Quaid-e-Azam Medical College (QAMC), Bahawalpur, Pakistan
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Chen L, Chen YM, Wang LJ, Wei J, Tan YZ, Zhou JY, Yang Y, Chen YM, Ling WH, Zhu HL. Higher homocysteine and lower betaine increase the risk of microangiopathy in patients with diabetes mellitus carrying the GG genotype of PEMT G774C. Diabetes Metab Res Rev 2013; 29:607-17. [PMID: 23794489 DOI: 10.1002/dmrr.2432] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 05/04/2013] [Accepted: 06/17/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Diabetes represents one of the greatest medical and socioeconomic threats worldwide. The pathogenesis involved is complicated. The effect of methyl donors and genetic polymorphisms in metabolic enzymes on the risk of microangiopathy in patients with diabetes is not well understood. This study investigates the association of homocysteine, choline and betaine levels and phosphatidylethanolamine N-methyltransferase (PEMT) G774C (rs12325817) genotypes with the risk of diabetes and its related microangiopathic complications. METHODS Between January 2009 and June 2010, 184 diabetic patients and 188 non-diabetic control subjects were enrolled in the hospital-based case-control study. Serum concentrations of betaine and choline were determined by high-performance liquid chromatography (HPLC)-mass spectrometry. Serum concentrations of homocysteine were assayed using HPLC. PEMT gene mutations were detected by polymerase chain reaction and restriction fragment length polymorphism. RESULTS After adjustment for potential confounders, serum total homocysteine had a significant dose-dependent positive association, and serum choline had an inverse association with the risks of diabetes and its microangiopathic complications (both p < 0.001). Although serum betaine was not associated with the risk of diabetes, it had a significant inverse association with diabetic microangiopathy. Compared with GG genotype, the CC genotype of PEMT G774C was associated with a decreased risk of diabetes (OR 0.559, 95% CI 0.338, 0.926) and its microangiopathy (OR 0.452, 95% CI 0.218, 0.937). CONCLUSION The GG genotype of the PEMT G774C polymorphism, higher levels of serum homocysteine and lower levels of serum betaine are associated with an increased risk of microangiopathy in patients with diabetes.
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Affiliation(s)
- Li Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
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Wang J, Zhang RY, Chen RP, Sun J, Yang R, Ke XY, Chen H, Cai DH. Prevalence and risk factors for diabetic retinopathy in a high-risk Chinese population. BMC Public Health 2013; 13:633. [PMID: 23826664 PMCID: PMC3733656 DOI: 10.1186/1471-2458-13-633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 07/02/2013] [Indexed: 12/02/2022] Open
Abstract
Background Lifestyle plays an important role in the development of diabetic retinopathy. The lifestyle in Guangzhou is different from other cities in China as the Cantonese prefer eating rice porridge, but not spicy foods. The objectives of this study were to investigate the prevalence and determinants of diabetic retinopathy in a high-risk population of Guangzhou. Methods Subjects (619 totals) aged over 45 years old, without known diabetes were recruited from five randomly selected Guangzhou communities in 2009–2010. All participants were invited to complete the Finnish Diabetes Risk Score (FINDRISC) questionnaire. Subjects with FINDRISC score ≥ 9 were included in the study, and underwent an investigation of demographic data, a standardized physical examination, ocular fundus examination, and laboratory analyses. The minimum criterion for diagnosis of diabetic retinopathy was the presence of at least one microaneurysm. Results Of 619 subjects, 208 eligible subjects (122 women) with FINDRISC score ≥ 9 were included in the study. The mean age was 69.2 ± 8.5 years. Diabetic retinopathy was detected in 31 subjects, and the prevalence of diabetic retinopathy in subjects with high risk for diabetes was 14.9%. In binary logistic regression analysis, risk factors associated with diabetic retinopathy were history of impaired glucose regulation [odds ratio (OR), 7.194; 95% confidence interval (CI): 1.083, 47.810], higher hemoglobin A1c (HbA1c; OR, 2.912; 95% CI: 1.009, 8.402), higher two-hour postprandial plasma glucose level (OR, 1.014; 95% CI: 1.003, 1.025), and presence of microalbuminuria (OR, 5.387; 95% CI: 1.255, 23.129). Conclusions Diabetic retinopathy was prevalent in a high-risk Chinese population from Guangzhou. Histories of impaired glucose regulation and microalbuminuria were strong risk factors for diabetic retinopathy.
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Affiliation(s)
- Jiao Wang
- Department of Endocrinology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Jammal H, Khader Y, Alkhatib S, Abujbara M, Alomari M, Ajlouni K. Diabetic retinopathy in patients with newly diagnosed type 2 diabetes mellitus in Jordan: prevalence and associated factors. J Diabetes 2013; 5:172-9. [PMID: 23163974 DOI: 10.1111/1753-0407.12015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 10/29/2012] [Accepted: 11/05/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To determine the prevalence of diabetic retinopathy (DR) in patients with newly diagnosed type 2 diabetes mellitus (T2DM) in Jordan, as well as the factors associated with DR. METHODS A cross-sectional study was conducted among 127 consecutive newly diagnosed (within the past 6 months) patients with T2DM attending one of two diabetic care centers. Complete ocular examinations were performed by an ophthalmologist and relevant data were collected. A fundus examination was performed using slit lamp indirect ophthalmoscopy after pupillary dilation with 1% tropicamide drops, with DR defined and classified according to the scale developed by the Global Diabetic Retinopathy Project Group. RESULTS Of all the patients examined, 7.9% had DR. Of those with DR, 40% already had clinically significant macular edema necessitating laser photocoagulation or intravitreal injections. Multivariate analysis revealed that age and HbA1c were significantly associated with DR. The odds of DR increased by 11% for each 1 year increase in age (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.02-1.20). For each 1% increase in HbA1c, the odds of DR increased by 43% (OR 1.43; 95% CI 1.09-1.88). CONCLUSIONS Fewer than one-tenth of newly diagnosed Jordanian patients with T2DM had DR, but more than one-third of these patients had significant maculopathy. Therefore, early screening is strongly recommended for all newly diagnosed T2DM patients. Increased age and HbA1c values are associated with increased odds of DR. A study with a larger sample size is needed to elucidate the risk factors for DR in newly diagnosed T2DM.
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Affiliation(s)
- Hisham Jammal
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
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Ruta LM, Magliano DJ, Lemesurier R, Taylor HR, Zimmet PZ, Shaw JE. Prevalence of diabetic retinopathy in Type 2 diabetes in developing and developed countries. Diabet Med 2013; 30:387-98. [PMID: 23331210 DOI: 10.1111/dme.12119] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND As the global prevalence of diabetes increases, so will the numbers of people with diabetic retinopathy. Our review aimed to provide a comprehensive picture of available studies of diabetic retinopathy and how prevalence varies around the developed and developing world. METHODS A detailed literature search using PubMed was undertaken. The following search term was used: 'diabetic retinopathy AND prevalence'. The titles and abstracts of all publications identified by the search were reviewed and 492 studies were retrieved. Inclusion and exclusion criteria were applied. RESULTS A total of 72 articles from 33 countries were included. There were only 26 population-based studies using fundus photography (12 in developing countries), of which only 16 (eight in developing countries) were published since 2000. Prevalence estimates varied from as low as 10% to as high as 61% in persons with known diabetes and from 1.5 to 31% in newly diagnosed diabetes. Across all the studies, the median (interquartile range) prevalence of any diabetic retinopathy in known diabetes was 27.9% (22-37%) and 10.5% (6-16%) in newly diagnosed diabetes. Prevalence of diabetic retinopathy was higher in developing countries. CONCLUSION Significant gaps exist in that reliable population-based data from developing nations and indigenous populations in particular are lacking. Major differences in study characteristics and methodologies make comparisons very difficult. More research is required and study methodologies must be better standardized. This will provide important information for prevention and treatment strategies.
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Affiliation(s)
- L M Ruta
- Baker IDI Heart and Diabetes Institute, The University of Melbourne, Melbourne, Vic., Australia
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Liu L, Wu X, Liu L, Geng J, Yuan Z, Shan Z, Chen L. Prevalence of diabetic retinopathy in mainland China: a meta-analysis. PLoS One 2012; 7:e45264. [PMID: 23028893 PMCID: PMC3447927 DOI: 10.1371/journal.pone.0045264] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 08/14/2012] [Indexed: 11/18/2022] Open
Abstract
Background Although diabetic retinopathy (DR) is considered to be a major cause of blindness, this is the first meta-analysis to investigate the pooled prevalence of DR in mainland China. Methodology/Principal Findings We conducted a search of all English reports on population-based studies for the prevalence of DR using Medline, EMbase, Web of Science, Google (scholar), and all Chinese reports were identified manually and on-line using CBMDisc, Chongqing VIP database, and CNKI database. A meta-analysis was carried out. The fixed effects model or random effects model was used as a statistical test for homogeneity. Nineteen studies were included. The prevalence of DR, non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR) in the pooled general population was 1.3% (95%CI: 0.5%–3.2%), 1.1% (95%CI: 0.6%–2.1%), and 0.1% (95%CI: 0.1%–0.3%), respectively, but was 23% (95%CI: 17.8%–29.2%), 19.1% (95%CI: 13.6%–26.3%), and 2.8% (95%CI: 1.9%–4.2%) in the diabetic group. The prevalence rate of DR in the pooled rural population was higher than that in the urban population, 1.6% (95%CI: 1.3%–2%), and the diabetic population, 29.1% (95%CI: 20.9%–38.9%). The prevalence of DR was higher in the Northern region compared with the Southern region. Conclusions/Significance The prevalence of DR in mainland China appeared a little high, and varied according to area. NPDR was more common. This study highlights the necessity for DR screening in the rural areas of China.
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Affiliation(s)
- Lei Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Xiaomei Wu
- Department of Clinical Epidemiology and Evidence Medicine, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Limin Liu
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Jin Geng
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhe Yuan
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Zhongyan Shan
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Lei Chen
- Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Key Laboratory of Endocrine diseases in Liaoning Province, The First Hospital of China Medical University, Shenyang, People's Republic of China
- Liaoning Diabetic Eye Center, The First Hospital of China Medical University, Shenyang, People's Republic of China
- * E-mail:
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Endoplasmic reticulum stress-related factors protect against diabetic retinopathy. EXPERIMENTAL DIABETES RESEARCH 2011; 2012:507986. [PMID: 22203836 PMCID: PMC3235773 DOI: 10.1155/2012/507986] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 08/20/2011] [Accepted: 09/21/2011] [Indexed: 01/12/2023]
Abstract
The endoplasmic reticulum (ER) is a principal mediator of signal transduction in the cell, and disruption of its normal function (a mechanism known as ER stress) has been associated with the pathogenesis of several diseases. ER stress has been demonstrated to contribute to onset and progression of diabetic retinopathy (DR) by induction of multiple inflammatory signaling pathways. Recent studies have begun to describe the gene expression profile of ER stress-related genes in DR; moreover, genes that play a protective role against DR have been identified. P58IPK was determined to be able to reduce retinal vascular leakage under high glucose conditions, thus protecting retinal cells. It has also been found by our lab that ER-associated protein degradation factors exhibit significantly different expression patterns in rat retinas under sustained high glucose conditions. Future research based upon these collective genomic findings will contribute to our overall understanding of DR pathogenesis as well as identify potential therapeutic targets.
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